Many medical procedures require insertion and manipulation of a scope, such as a borescope, fiberscope, videoscope, neurosurgical scope or intubating scope. Taking the example of an intubating scope, the procedure often requires insertion of the scope into an endotracheal tube (ETT), which is further inserted into the trachea of a patient. The ETT ensures proper ventilation in the patient, and also allows for the delivery of various gases to the patient, such as an anesthetic or oxygen.
In a typical intubation procedure, the ETT is introduced through the mouth of the patient. Simultaneously, a metal laryngoscope blade (i.e., Miller or MAC Blade) can be used to move the patient's tongue so that the patient's epiglottis and vocal cords can be viewed by the operator. The ETT is then advanced until it is positioned at the proper location in the patient's trachea. Once the ETT is properly positioned, a cuff affixed to the ETT can be inflated to seal the patient's airway passage and allow for the flow of ambient gases. A proper procedure firmly fixes the endotracheal tube in place in the patient's trachea. At this time, the laryngoscope can be withdrawn leaving the ETT in the body.
In some situations, the patient's epiglottis or anatomical features, blood or other secretions, and sometime even debris, may present what is known as a “difficult airway”. In a difficult airway situation, the currently available metal laryngoscope blades can cause trauma to soft tissue, teeth and other areas of the patient due to, in part, the size, rigidity and low versatility of the blade. As a result, some practitioners have begun using flexible scopes which are inserted into the ETT, some of which allow the practitioner to view the airway during insertion of the ETT into the trachea via fiber-optics, to avoid inducing trauma to sensitive features of the airway. The tip of the scope contains an imaging element which communicates images from the distal end of the scope (typically located near the distal end of the ETT) to the proximal end of the scope, and then to a portable monitor or eyepiece. The images displayed on the monitor or eyepiece can be viewed by the operator during insertion of the ETT.
However, prior art devices currently available are ineffective for manipulating soft tissue in the airway and dealing with secretions and other debris to obtain a clear view of the tracheal inlet. If the tip of the scope is covered or obscured by soft tissue, secretions or other debris, the practitioner will obtain an inaccurate or incomplete image of the trachea, and an effective intubation will likely be delayed. Patients in emergency situations require effective intubations on the practitioner's first intubation attempt.
For example, U.S. Pat. No. 5,817,015 to Adair discloses an endoscope having at least one longitudinal channel formed around its periphery for transmitting fluids or for receiving an operative instrument or carrying light transmitting fibers. However, Adair does not disclose an apparatus capable of injecting gas or fluid other than in a longitudinal direction, and thereby providing freedom to navigate a scope in a tight or difficult passageway.
U.S. Patent Application Publication No. US 2006/0047184 to Banik, et al. discloses an endoscopic imaging system for examining a patient's body cavity including an endoscope having a distal end, a proximal end and a number of lumens therein. One or more distal gas ports are disposed at or adjacent the distal end of the endoscope. Banik et al. also fails to disclose injecting gas or fluid in a non-longitudinal direction, and furthermore does not provide for the symmetrical arrangement of ports as does the current invention.
U.S. Pat. No. 5,685,823 to Ito, et al. discloses an endoscope including a front end having fluid discharge openings, and further having a fluid injection nozzle connected to the fluid discharge opening. The '823 patent only discloses the injection of fluid through discharge openings located at the front end, which are limited in the direction of flow of fluid or other substance transmitted through the injection nozzles. Ito et al. do not teach utilizing the injection of gas or fluid to clean or clear a lens prior to exit from the discharge opening.
U.S. Pat. No. 5,464,008 to Kim discloses a defogger for the objective lens of a laparoscope providing a channel in a longitudinal direction of the laparoscope. Gas from an insufflator is supplied to the channel exteriorly of a body being operated upon. While the channel directs gas across the surface of the objective lens, it does not direct gas or fluid outwardly for clearing an area in front of the lens.
Thus, a need exists for providing an intubating scope that can be used in conjunction with an ETT in difficult airway situations that is effective in dealing with obstructive soft tissue, secretions and other debris, and is easy to use. Furthermore, there is a need for an intubating scope that is flexible and allows for redirection of the distal tip within the difficult airway. There is a further need to provide a display for viewing images wirelessly from the imager of a scope that may be attached to multiple surfaces, including, but not limited to, the handle of a laryngoscope blade. There is also a need to provide a method and system for continuously or selectively cleansing the lens of an intubating scope during intubation procedures, in part by directing a significant portion of the ejected gas or fluid in a at least partially tangential direction to the surface of the lens of the intubating scope.